REQUEST INFORMATION

We would like to hear from you. Please provide us with some basic information and what you are interested in and we will furnish you with your information

Please note that the . The more detailed information you provide will allow us to quote you more accurately! Medicare Supplement rates during your Initial Enrollment Period are based on your age, gender, zip code and whether or not you smoke. Without all of this information we can not send you a quote.

This is a solicitation for insurance. By providing this information, you agree that an authorized representative or licensed insurance agent/producer may contact you by phone, email, or mail to answer questions or provide additional information about Medicare Supplement Insurance plans items marked with * are required to submit the form

Personal Information

* First Name

* Last Name

* Birth Date

* Gender

MaleFemale

Smoke

Spouse Information (if you want quoted)

Spouse Full Name (if you want quoted)

Birth Date

Gender

MaleFemale

Smoke

Mailing Information

Address

City

State

* Zip Code

Phone number

* eMail address

* Contact Approval

Additional Info

Message

Additional Medigap Information

Medigap Plan F offers a high deductible option. You must pay for Medicare-covered costs up to the high-deductible amount ($2,240 in 2018) before your Medigap policy pays anything.

100% part B coinsurance except up to $20 copayment for office visits and up to $50 copayment for ER.

You must also pay a separate $250 deductible for foreign travel emergency and there is a $50,000 lifetime maximum benefit.

After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($185 in 2019) the plan pays 100% of covered services for the rest of the calendar year (This applies only to plans K & L) - [Excess charges do to apply to maximum out of pocket].

Modified Plan F offers an individual assistance program, as well as coverage for preventive dental care (available in some states).

2018 Out of Pocket Limit for Plan K is $5,240.

2018 Out of Pocket Limit for Plan L is $2,620.

Initial Enrollment

You must be enrolled in both Medicare Part A and Medicare Part B and live in the plan's service area to be eligible for these plans.

You are first eligible during the 7-month Initial Coverage Enrollment Period (ICEP), the 3 months before your 65th birthday, the month of, and 3 months after. CAUTION: You only have one choice so take your time, ask for help and choose wisely.

You must continue to pay your Medicare Part B premium in addition to any plan premium shown below.

About the Information Presented

This is a web site from CDA Insurance LLC. CDA Insurance LLC is not an insurance carrier, we are an agency that represents many companies offering products to the general public and also to medicare recipients. We do our best to assure that all information presented on our web site is current and accurate.

CDA Insurance LLC is not associated with Medicare or the Center for Medicare and Medicaid Services. This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE or consult www.medicare.gov.

A Medicare Supplement plan is a health insurance plan provided by a private company that fills in the “gaps” in original Medicare coverage. CDA Insurance LLC is an agency that sells Medicare Supplement plans to medicare beneficiaries. Submitting our online quote request form does NOT affect your current enrollment, nor will it enroll you in a Medicare Supplement plan or other Medicare plans. To apply for coverage you must submit an application for the company and plan that you want.